Did the patient really need
5 referrals for a "complete" check-up? One Doctor, a
trained Generalist could do the job--including the more
intimate examinations.

mus

So Why So Many Referrals?

The main reason
is because the title Primary Care Physician (PCP)
is all inclusive and
misapplied. It has been defined by some as the “as the first medical
contact with new patients, individuals first entering the Health Care
(HC) System. As a result the category of PCPs includes:

The
Dermatologist (doesn’t check eyes )

The
Internist (refers intimate exams to gynecologists, proctologists)

The
Gynecologist (Refers skin conditions to dermatologists)

ETCETERA

The
good Generalist (aka Primary Care) mange these problems—and then some!

An oft heard
comment about Family Doctors and/or PCPs is “All s/he does is write
prescriptions and refer me”. When patient care is so fragmented who is
in charge?

Why did Primary
Care Decline?

The threat of
mal-practice litigation! Actually the PCP should be an accomplished
Generalist, a Doctor competent in the office practice and simple
procedures of Specialty Care. But in the present environment that would
be like driving with an insurance card but without a license.

The doctors
must be trained Generalists competent in many of the office procedures
of the specialties as well as procedural medicine (minor surgery, remove
ear wax, suture lacerations). They will be responsible for the
management of the care of their patients.

Isn’t That Socialized Medicine?

What a question! You must be kidding!

Call it whatever you want!

Most Americans
receive medical Care through government auspices:

Medicare

Medicaid (Federal and State for medically
indigent)

Veterans

Indian Health Services

Individually Covered Groups

Dialysis

Addiction Services

HIV
sufferers .

Benefits of Homogeneous General Medicine

Summary in Brief

A coordinated system of
robust Primary (General Medicine) Care Centers will include these
benefis:

1.Assure
that General Medical Care will be practiced uniformly throughout the
United States

2.
Quality of medical care will be improved

3.
General Medical Care will be available to everybody in the country at
rates ranging from Zero to Affordable

4.
General Medical Care Centers will help coordinate National response to
disasters plagues and terror.

During the past
30 years Primary Care Medicine has become increasingly debilitated. Now
it is only a shell game of its old self. How did this happen? How can it
be fixed?

If the Supreme
Court voids all or only portions of the Affordable Health Care Act some
sort of substitute would probably be enacted. That would give the
Congress and Administration an opportunity to analyze the nature of
Primary Care practice within the context of the delivery of Medical
Care.

Although High
Tech Medical and Surgical specialties are practiced uniformly at the
highest level throughout the country Primary Care doesn’t fare that
well. Too often people disparage their “Primary” as a doctor who “does
nothing but write prescriptions and refer me.”

Primary Care
has shriveled because too many of its practitioners have divested
themselves of most of the office practices and responsibilities that
were second nature to my generation of physician: namely the “ever
available” Family Doctor, diagnostician and caretaker capable of
performing many in-office procedures now referred out to the various
Specialties. That Family Doctor assumed that those in his care were His
(or Her) Patients, to be guarded and guided, not to be handed-off,
needlessly referred because a small laceration had to be sutured,
because ear-wax had to be removed or a number of other minor problems
could not be attended. This retreat to safer harbors deprives patients
of that parental assurance heretofore associated with “The Family
Doctor”, wastes their time in other waiting rooms and results in costly
fee multipliers associated with unnecessary referrals.

A major reason
for this more passive role assumed by the Primary Care Doctor is rooted
in the threat of Medical Malpractice Litigation—because physicians
crossing boundaries that define the specialties are unable (during
interrogations or court appearances) to answer the inevitable question
“Doctor when did you pass the tests to get credentialed in all [ent,
gyn, surgery, dermatology] these specialties?

Regardless of
outcome, the mere hint of legal attack initiates a chain reaction that
may jeopardizes every aspect of a doctor’s professional life. The
relations with HMOs and Hospitals become sensitized, insurance rates may
rise, rumors are are floated. So why bother with these risks? Let’s play
it safe. We will consult with families (no liability there), practice
“Preventive Medicine (no liability there) and treat patients according
to advice and prescriptions of their specialists (no jeopardy here). Our
new credo: Advise and Consent, that’s it. Result: the patient loses a
medical guardian and costs rise according to the number of referrals
that might otherwise be avoided. ($50 billion? $100 billion? Who knows?

The remedy is
seeded in the 8000 or more Primary Care Centers of America, not-for-
profit corporate bodies funded in part by grants from the Department of
Health via the Health Resources and Services Administration. Here
Physician employees are protected from the eviscerating attacks of
medical malpractice by the Federal Tort Claims Act. This Act gives
citizens the right to sue the Government in Federal Court. Thus patients
have recourse to litigation naming the physician as malefactor.
Physicians on the other hand may be punished or fired but are relieved
of blood curdling awards for “pain and suffering”, and unwelcome
publicity these cases may attract.

Were the number
of these Primary Care Centers increased to satisfy the needs of the
nation, properly trained Physician employees would be free to cross
Specialty boundaries and enjoy a robust and fulfilling office practice
in General Medicine.

The other
substantial benefits of robust and Affordable Primary Care are addressed